Chronic Condition Case Manager RN at Hines & Associates Inc

About us

Hines is a nationwide, independent leader in personalized managed health care, focused on what's important to you—comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.'s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.

What we offer

• Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company paid life insurance.
• 401k plan with company match, fully vested after 1 year.
• Paid holidays and time off.
• Work-life balance.
• No weekends or holidays!
• Hybrid setting; up to 2 days per week remote.

Overview

Our Chronic Condition Manager role allows you to utilize your clinical nursing experience to develop a plan for meeting health care needs of the patient, while continuing to professionally grow in health care knowledge and perspective. Be the patient advocate you desire to be!

In this key role, the ideal candidate will be responsible for utilizing medical knowledge to assess patient and provide individualized coaching for the purpose of developing a plan for meeting the health care needs and patient's goals of self-management of chronic medical conditions. The Chronic Condition Manager is accountable for telephonic assessment, planning, implementation, coordination, education, monitoring, evaluation and outcomes measurement. The Chronic Condition Manager is a patient advocate, promotes safety and maintains privacy and confidentiality in accordance with policies and procedures.

Duties and Responsibilities

• Identify problems while assessing the patient's medical and psychosocial status, including environmental and cultural influences.
• Determine economically responsible options available to meet the patient's medical and care needs,
• Understand policy/benefit plans and systems.
• Collaborate with physician(s), provider(s), and patient/family and payers to facilitate quality, timely and efficient medical care across the healthcare continuum.
• Implement disease management plan by coordinating resources, including community resources, healthcare providers and significant others.
• Evaluate the disease management plan and its effects on the patient and make modifications as necessary.
• Improve the health outcomes and quality of life with reduced complications and costs for persons with chronic health conditions.
• Promote patient self-management of chronic health conditions through individual assessment, education and use of motivational interviewing principles/techniques.
• Utilizes clinical practice guidelines and promotes best care for people with chronic medical conditions
• Demonstrate ability to communicate effectively with TPAs, insurers, physicians, patient/family, and other healthcare providers, including ability to negotiate with assertiveness.
• Effectively communicate the disease case manager's impressions of methods available to provide for the medical needs of the individual patient or the need to refer to a higher level for review of questionable plans of treatment.
• Provide written documentation concerning the information obtained regarding the patient's status, treatment plan and disease management interventions.
• Interfaces with UM, CM and peer review, and other programs, as indicated on active cases.
• Communicate knowledge of policy and procedure, standards of practice, and their revision; Participates in annual HIPAA, ethics, cultural, and URAC standards training.
• Provide good customer relations by promoting good will and understanding between claimant, payer, providers and professional staff at all times.
• Acts as an advocate, maintains privacy, confidentiality, promotes safety, and is compliant with policies and procedures, URAC standards and other regulatory standards.
• Responsible for and retains accountability for the disease management plan and process when using assistance of support staff; provides input on the support staff to their supervisor.
• Special projects as assigned by supervisor.

PM21

Qualifications

• Registered nurse with current unrestricted license to practice in the state or in a state that has licensure reciprocation with the state of the office location that employee is working in. Registered Dietitian practices under current unrestricted registration as dictated by the Commission on Dietetic Registration.
• Successful completion of disease management orientation program.
• Minimum of 2 years full time equivalent of direct clinical care to the consumer.
• Excellent communication skills.
• Basic typing/computer knowledge with minimum keyboarding speed of 35 WPM.
• Previous disease management or case management experience helpful but not required.
• Obtaining certification in CCM or CHC is encouraged.

Physical requirements

• No significant physical exertion required.

*Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.*

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